Provider Demographics
NPI:1619186103
Name:SOUTHWEST THERAPY SOLUTIONS LLC
Entity Type:Organization
Organization Name:SOUTHWEST THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:580-252-3054
Mailing Address - Street 1:1107 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-3767
Mailing Address - Country:US
Mailing Address - Phone:580-606-0123
Mailing Address - Fax:
Practice Address - Street 1:711 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-3313
Practice Address - Country:US
Practice Address - Phone:580-658-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA307171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty